DR. DEUK

What about doctors giving a warranty for their work?

Workcompcentral’s Ben Miller produced an interesting piece about a Florida spine surgeon, Dr. Ari Deukmedjian, who apparently does just that. Apparently the warranty is available if an insurer pays the Deuk Spine Institute’s billed rate rather than the rate dictated by Florida’s workers’ comp fee schedule.

Well known industry commentator Joe Paduda told Workcompcentral’s Miller that he wasn’t impressed.

Miller notes that “According to Paduda, CMS refuses to pay for certain things – hospital readmissions, hospital-acquired infections and what he called “never-ever events” like amputating the wrong limb or sewing up a sponge inside a person.”

“What (Dr. Deukmedjian is) essentially saying is, ‘You have to pay me to take on the risk for something that I maybe should have gotten right in the first place,’” Paduda said. “What CMS is saying is, ‘You should have gotten this right in the first place.’ And I personally think the Medicare model is much more appropriate.”

Or is it? It’s the age old question of whether it is best to incentivize success or punish failure.

Could some patients and payers best be served by “flat fee” arrangements? After all, some insurance carriers pay their workers’ comp defense counsel on this basis.

One problem is defining success. By return to work outcome in a workers’ comp context? By bringing the worker to pain free or at least pain acceptable status? By achieving measurable improvement over pre-treatment status?

Who defines when the warranty is fulfilled and when it is breached? To what extent is this legally enforceable by a patient?

I’d agree with Paduda that this seems to be a marketing gimmick. And is suspect that few payers would agree given the questions that swirl around such an arrangement.

Still, it’s interesting to think about out-of-the box arrangements. Should we be bonusing doctors who get exceptionally good results? Should workers who return to work earlier than expected receive some sort of incentive compensation?

How can we best use the dollar to reinforce good outcomes? I don’t have easy answers. But these sorts of questions may take on added importance as stakeholders look for more system efficiencies.

Stay tuned.

Julius Young